Le bénéfice d'un traitement par dronabinol au long cours pour la douleur neuropathique est-il durable ? Sept ans d'observation dans un Centre d'étude et traitement de la douleur en France.

Real-life data from various countries have shown that long-term use of a cannabinoid is possible for the treatment of certain chronic pain conditions, without risk of addiction and with maintenance of an overall benefit on quality of life. The retrospective evaluation presented considers the duration of dronabinol treatment for neuropathic pain in a Center for Pain Evaluation and Treatment (CETD). Between 2016 and 2023 (7 years and 2 months), 165 patients were followed up, 57 % with central pain (DNC) and 43 % with peripheral pain (DNP). Various data were collected once a quarter: analgesic efficacy, adverse events, overall benefit of treatment. Continuation of treatment was considered in the absence of contraindication or treatment-related adverse event, and when the patient requested continuation of treatment without increase in dosage because overall benefit was maintained. The duration of dosage adjustment varied between 1 and 4 months, and daily doses were stable for each patient, ranging from 2.5 to 40 mg. 64 % of patients discontinued treatment within the first 12 months, 44 % within the first 6 months due to inefficacy or intolerance. After 6 months, reasons for discontinuation were never adverse effects or addiction. During the first 2 years, 78 % of patients stopped treatment. At the end of the study, the longest duration of treatment was 7 years and 2 months. Mean duration of treatment was 17 ± 22 during the evaluation. Mean duration of treatment for patient still taking the treatment at the end of evaluation was 41 ± 4 months with DNC (95 % CI: 33–49) and 25 ± 3 months with DNP (95 % CI: 19–31). The proportion of patients receiving treatment for at least 1 year was 68.4 % (39/57) with DNC and 40.8 % (20/49) with DNP, the difference being statistically significant between the 2 groups only at 2 years of treatment (DNC: 39.1 % (27/69) and DNP 17 % (10/59), p = 0.038). The probability of time remaining before a patient stopped treatment was significantly different between the DNC and DNP groups (p = 0.023). With the advent of medical cannabis in France, the real-life data from our study and the literature show that the long-term use of a cannabinoid for the treatment of DN can be envisaged without any major risk, whether addictive or otherwise, and that it can provide a significant and durable benefit in terms of quality of life, justifying its use as a last-line treatment, with a focus on central pain. [ABSTRACT FROM AUTHOR]